| Certificate Number | 235 | | Date Issued |
| Child Given Name | |
Holcomb | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 21 Aug 1881 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Henry M. |
Holcomb | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 27 | Father's Age |
| Mother's Given Name | Morgan | Holingsworth | Mother's Maiden Name |
| Mother's Surname | Holcomb | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Marshall Co IA | Mother's Birth Place |
| Mother's Age | 19 | 1 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Lincoln Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton | Lincoln Twp IA | Certificate Signer's Address |
| Returned by Name | F.S. Newton | | |